This Program Project, Cancer Screening, Managed Cared, and the Undeserved addresses the major impediments to achievement of the breast and cervical cancer screening goals for the Year 2000: . screening for women who have never been screened; . establishment of maintenance screening behavior; and .improved follow-up of abnormal tests to diagnosis and treatment. Despite notable gains in these areas, low-income and multi-ethnic populations still suffer disproportionately high rates of late-stage disease and mortality due to these cancers. Moreover, advances to data may be jeopardized by the complexity and rapid changes as the delivery of health services evolves into managed care. The proposed research, collectively referred to as the Pathfinders studies, seeks to unravel the impediments to early detection and develop viable, cost-effective solutions. Our investigators are a multi-disciplinary and multi-ethnic team from San Francisco Bay Area research institutions and are members of the Northern California Cancer Center (NCCC) consortium. The team will build on past experiences in studies of under-served populations to tackle critical behavioral and health services research questions. Three projects linked by the Pathfinders them address these issues: 1) Access and Early Cancer Detection for the Under-served 2) A Strategy to Improve Pap Smear Follow-up in a High-risk Under-served Population 3) Race/ethnic Differences in the Evaluation of Abnormal Mammography The first two of these projects are randomized controlled trials that evaluate the effectiveness and cost-effectiveness of innovative interventions. The third study is an exploration of issues interfering with timely and complete resolution of mammographic abnormalities from the women's perspective and the piloting of a responsive intervention. In our core research we will also record and study the changes taking place in cancer screening as a result of the upheaval in health care delivery and methodologic problems in its evaluation. Core components will also provide cohesive services and methodologic, biostatistical, and cost-effectiveness analysis expertise. The proposed research will make a unique contribution to cancer control research and complement other cancer control activities of the NCCC and its consortium in Northern California.